Paul Wilson – Using Implementation Science to support adoption and spread
Identifying and accelerating health and care innovation at pace and scale remains a global challenge. In this blog Paul Wilson, our Implementation Science Lead at NIHR Applied Research Collaboration Greater Manchester (NIHR ARC-GM), explains how implementation science can play a role.
Identifying innovations that will deliver benefits for patients and health and care system and then ensuring their fast uptake into routine clinical practice is a major challenge for health systems across the world. Developing good ideas through research, demonstrating proven benefits and translating into routine practice for patient benefit can take years, sometimes decades.
NHS and research organisations, including national bodies Accelerated Access Collaborative and the AHSN Network and local organisations such as Health Innovation Manchester and NIHR ARC-GM, are seeking to reduce this gap. The goal is to provide faster access to novel technologies and products to improve the health and care that people receive.
How best to do this can be challenging but, fortunately, a large and growing body of research evidence exists that can be harnessed to support adoption and spread – implementation science.
Implementation science is the scientific study of methods to promote the systematic uptake of evidence-based products, practices and polices into routine clinical practice.
The focus of the field is threefold. First, it encompasses theory and research exploring the systems, behaviours and practices that can act as barriers or enablers to implementation. Second it involves the design and evaluation of strategies that seeks to address those barriers or support enablers to implementation in a given context. Finally, there is a focus on understanding the process of implementation itself - what actually gets implemented and sustained where, when, why and how.
This evidence can be harnessed in three ways:
- Better understand the effects of innovations within the real-world conditions and populations
- Early identification of barriers and enablers to understand how innovations can be successfully implemented to inform wider uptake and spread.
- Produce ‘actionable evidence’ to support decision making on the commissioning and uptake of innovations more widely.
One of the ways we can use implementation science to support adoption and spread is by using Consolidated Framework for Implementation Research (CFIR) to identify what support is needed for successful implementation of a product, pathway or technology.
Grounded in theory and research about how ideas spread in social systems, CFIR is widely used and comprises a comprehensive taxonomy of factors likely to influence the implementation of innovations. These include:
- The features of the innovation that might influence implementation
- The place where implementation will occur
- The wider economic, political and social environment within which implementation will occur
- The nature and type of people involved and how they influence the process of implementation
- How the process of implementation is actually enacted
Using a framework in this way provides a systematic basis for understanding the feasibility, acceptability and costs of different delivery models for any given innovation.
By harnessing research-based knowledge on implementation and applying it much earlier in the traditional development pathway, it can help us to identify the best ways to speed up adoption and spread across the NHS.